AB0293 RISK FACTORS ASSOCIATED WITH VENOUS THROMBOEMBOLISM IN RHEUMATOID ARTHRITIS IN CLINICAL PRACTICE
Authors: F. Oudart, M. Thomas, A. Combier, A. Moltó, Y. Allanore, J. Avouac
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Increased risk of venous thromboembolism (VTE) has been reported in rheumatoid arthritis (RA) compared to the general population [1]. However, factors associated with the risk of VTE have been barely studied in RA. <h3>Objectives</h3> To identify classical or disease-related risk factors of VTE in RA patients in clinical practice. <h3>Methods</h3> Retrospective observational study performed on all RA patients fulfilling the 2010 ACR/EULAR clarification criteria attending the one-day hospitalization program of the Rheumatology department, Cochin hospital, in 2021. We used the electronic medical report to identify the occurrence of VTE in 2021 and collect RA disease characteristics and risk factors for VTE. Multivariate analysis by logistic regression was performed to determine the factors independently associated with VTE. <h3>Results</h3> We included 317 RA patients (263 females, 83%), with a mean age of 59±14 years and a mean disease duration of 16±14 years. Positive rheumatoid factor and positive anti-CCP antibodies were detected in 255 (80%) and 271 (85%) patients respectively. 190 patients (60%) had erosive disease. The mean DAS28 was 3.5±1.4 and the mean CRP level was 6.8±15.9 mg/L; 161 patients (51%) received corticosteroids (mean dose 3.0±3.5 mg/L), 195 (62%) methotrexate, and 151 (48%) targeted biologic or synthetic DMARDs (b/tsDMARDs), including 60 on TNF-α inhibitors, 34 on rituximab and 27 on JAK inhibitors (10 baricitinib, 7 tofacitinib and 10 upadacitinib). We identified 12 (4%) venous thromboembolic events that occurred in 2021, including 9 PVT and 6 PE (incidence of 3.8 for 100 patient/year). The mean duration between the occurrence and VTE and the visit was 3.6±4.8 months. Among these 12 VTE patients, 9 were women (75%, vs. 97% in patient without VTE, p&lt;0.001), with a mean age of 65±12 years (vs. 59±15, p=0.14). Age &gt;65 years was more frequent in patient with VTE (58% vs. 33%, p=0.064); 7 (58%) patients with VTE had a history of previous VTE (vs. 3%, p&lt;0.001), 6 (50%) were hospitalized up to 6 months before the event (vs. 6%, p&lt;0.001), 3 (25%) experienced surgery up to 3 months bfore the event (vs. 2%, p&lt;0.001) and 4 (33%) had a history of fracture (vs. 3%, p&lt;0.001). No difference was oberved regarding body mass index, the frequency of smoking, neoplasia, recent travel (up to 3 months) and estrogen/antidepressant therapies. No patient had thrombophilia. Regarding RA characteristics, patients with VTE were more likely to present extra-articular manifestations (67% vs. 33%, p=0.015) and higher CRP levels (20±40 mg/L vs. 6.4±14.5 mg/L, p=0.006). They also received more frequently corticosteroids (83% vs. 50%, p=0.025) and JAKi (25% vs. 8%, p=0.041). Disease duration, autoantibody status, frequency of erosions, DA28 and treatment with methotrexate or bDMARDs did not differ between these 2 groups. Logitic regression analysis identified the following risk factors independently associated with the occurrence of VTE: history of previous VTE, hospitalization up to 3 months before the occurrence of VTE, surgery up to 6 months before the occurrence of VTE and treatment with JAKi (<b>Table 1</b>). <h3>Conclusion</h3> History of VTE was identified as the strongest risk factor of the occurrence of VTE. Our results suggest a specific warning on recent hospitalization and surgery as precipitating events to VTE. As recommended by the PRAC JAKi should be used with caution in patients with risk factors for VTE. <h3>Reference</h3> [1] Hu et al, Eur Rev Med Pharmacol Sci 2021 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Fiona Oudart: None declared, Marion Thomas: None declared, Alice Combier: None declared, Anna Moltó: None declared, Yannick Allanore: None declared, Jérôme Avouac Speakers bureau: Pfizer, Bristol Myers Squibb, Nordic pharma, Sanofis, Boehringer, Abbvie, Galapagos, Biogen, Fresenius Kabi, Sandoz, AstraZeneca, Lilly, Consultant of: Pfizer, Galapagos, Abbvie, Fresenius Kabi, Bristol Myers Squibb, Grant/research support from: Pfizer, Bristol Myers Squibb, Fresenius Kabi, Novartis, Nordic Pharma, Galapagos.